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jrbiz

?. Difference between Subcuticular & Facial closure techniques

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Hi everyone, i have a question.

 

 

I visited afew ht physicians for a revision and two that were recommended on this forum had told me these two different deep suture techniques.

 

 

So i ask you and maybe a physician can explain this.

 

What is the difference if there is one between a subcuticular closure technique and a Facial closure technique? Which technique is better/stronger for a scar from ear to ear?

 

 

Also, another ?.

 

The physician that does the facial closure offers free acell with the procedure. I thought this helps with healing or want i been told it could prevent the scar from returning red like i have now. But i just read in another thread that it will make the scar worse and not to use it.

 

 

The physician that does the subcuticular closure offers prp in combinations with acell for $1,200. Is this a waste of money or will it help my scar?

 

 

Thanks

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I just got my 2nd HT and this time he used a closure called the "tricho Closure" i am assuming that is the facial suture closure u speak of. I would definitely go that route as on my first HT tricho closure was not yet being preformed. I was told by my dr. that this new closure would help minimize and scarring. As for the use of any medicine on the scar. I would sugest neosporin or any antibiotic in the healing stages. and if you want less noticeable scars u could always use mederma or something like that.

 

Im not a physician, btw. hope that makes research easier for you.

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There are a lot of different suturing techniques that can be used in hair transplantation. Doctors also use different names to descibe the same techniques. The sub Q technique is generally a buried absorbable suture that is used to appoximate the wound margins and bury some of the tension deeper. It is surface tension (tension at the wound edges) that is a major factor in the formation of scar tissue. The facial closure technique is most likely a very fine suture that is used under minimal tension that helps to leave a smaller scar. A trichophytic closure can be used in combination with both of the above techniques. I generally use a two layered closure (deeper absorbable suture with no buried knots and a finer surface suture with two knots that needs to be removed 7-12 days post op) and add the trichophytic technique in certain cases.

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Probably a bigger factor than anything in your question paragraphs is: On average, does your doctor get good scars? If the answer is yes, I'd probably just do what he suggests, although I have no belief in adding potions and lotions to a simple closure in a healthy person. If the answer is no, I doubt if adding "extras" will make the difference.

 

Ask to see pics of a bunch of donor scars done by your doctor. Many of the coalition doctors post their scars with the results giving you something to compare to.

 

Good luck.

 

Dr. Lindsey McLean VA


William H. Lindsey, MD, FACS

McLean, VA

 

Dr. William Lindsey is a member of the Coalition of Independent Hair Restoration Physicians

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Hi everyone, i have a question.

 

 

I visited afew ht physicians for a revision and two that were recommended on this forum had told me these two different deep suture techniques.

 

 

So i ask you and maybe a physician can explain this.

 

What is the difference if there is one between a subcuticular closure technique and a Facial closure technique? Which technique is better/stronger for a scar from ear to ear?

 

 

Also, another ?.

 

The physician that does the facial closure offers free acell with the procedure. I thought this helps with healing or want i been told it could prevent the scar from returning red like i have now. But i just read in another thread that it will make the scar worse and not to use it.

 

 

The physician that does the subcuticular closure offers prp in combinations with acell for $1,200. Is this a waste of money or will it help my scar?

 

 

Thanks

 

jrbiz

 

1. Did you mean subcuticular or subcutaneous?

 

Like Dr. Charles, I routinely offer a 2-layer trichophytic closure. The deep layer is subcutaneous in the fat below the hair follicles. It provides strength and takes the tension away from the surface. Those sutures eventually dissolve. For the surface layer I use sutures that should be removed after 7 days to bring the edges together without tension. Before closing the surface, we remove a ledge from one edge of the incision so hair will later grow back through the scar.

 

Subcuticular sutures are usually dissolving sutures that replace the surface sutures. They are placed just under the surface of the skin and can be used as the top layer of a 2-layer closure. The advantage is that you don't have to return for suture removal. The disadvantage is that the dissolving time is variable and the sutures may get pushed to the surface before they dissolve and that could make the final recovery take a bit longer. I haven't used subcuticular sutures much but have seen some photos of nice trichophytic scars where subcuticular sutures were used.

 

2. Do you mean facial closure or fascial closure?

 

I haven't heard of a specific "facial closure". May be the doctor was talking about using a similar technique to what he or she uses when doing facial cosmetic surgery.

 

Fascia is a thick, strong band of (connective) tissue. In the scalp it is called the Galea Aponeurotica. Some surgeons use the strength of the Galea to reduce tension on the surface by either anchoring subcutaneous sutures to the Galea or by suturing the Galea itself. When scalp reductions were done, the Galea was cut then sutured together.

 

I am not a plastic surgeon and have never done a scalp reduction. I avoid cutting the Galea. I limit the depth of my incisions to just below the hair follicles in the subcutaneous layer. When I first started doing this newer 2-layer closure, I did anchor the sutures in the Galea as recommended by the author. However, I found that patients had more post-op pain. Since I kept the sutures only in the subcutaneous layer, my patients were much more comfortable and the scars were just as narrow.

 

It makes sense that the Fascia could give strength to the wound but there could also be more complications. What limited experience I had with using the fascia was negative but there may be doctors who know better how to use the strength of the fascia for revisions. Dr. Lindsey may have more to say about using the Galea (Fascia) in closures.

 

3. I am watching the debate about Acell and PRP with interest but haven't been compelled to try either yet.


Cam Simmons MD ABHRS

Seager Medical Group,

Toronto, Ontario, Canada

 

Dr. Cam Simmons is a member of the Coalition of Independent Hair Restoration Physicians

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